Bardoxolone - can glomerular filtration rate be increased safely in the long term even in patients with advanced

renal insufficiency?

Chronic kidney diseases are usually of progressive nature when a certain degree of reduced glomerular filtration rate is achieved. Inhibition

of the renin-angiotensin system slows but does not stop the progression of chronic renal insufficiency. In addition to haemodynamic

factors (glomerular hypertension), microinflammation and oxidative stress along with the progression of renal insufficiency obviously

play an increasingly important role. Bardoxolone activates the Keap1/Nrf2 system and has antioxidative and anti-inflammatory effects.

One-year treatment of patients with advanced chronic renal insufficiency with bardoxolone increased their glomerular filtration rate

by approximately 50 %. The BEACON study designed to assess the long-term efficacy and safety of treatment with bardoxolone was

discontinued because of increased incidence of adverse effects in the active arm. Only further studies, including a detailed analysis of

data from the BEACON study, will show whether it will be possible, for at least some subgroups of patients, to maintain the favourable

effect of bardoxolone and avoid the potential risks of this therapy.

Keywords: bardoxolone, progression of renal insufficiency, angiotensin-converting enzyme inhibitors, angiotensin II, Nrf2, oxidative stress